Active NPI
Charles Michael Davis, DO
- Family Medicine Physician
- Boise, ID
National Provider Identifier
1104877364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- O--0448
- Practice address
- 500 W Fort St
Boise, ID 83702-4501 - Phone
- (208) 422-1000
- NPI assigned
- May 13, 2006
- Last updated
- Feb 25, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | O--0448 | ID | Primary |
Addresses
Primary practice location
500 W Fort St
Boise, ID 83702-4501
Mailing address
500 W. Fort St.
# 111
Boise, ID 83702
Phone (208) 422-1325
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200609000532 | ID | Order and Referring Only - Family Practice | 3577658301 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| O--0448 | ID | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Alphonsus Regional Medical Center Inc | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Family Medicine Physician
- Caldwell, ID
- NPI 1861676298
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645747200000",
"number": "1104877364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 W. FORT ST.",
"address_2": "# 111",
"city": "BOISE",
"state": "ID",
"postal_code": "83702",
"telephone_number": "208-422-1325",
"fax_number": "208-422-1319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 W FORT ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837024501",
"telephone_number": "208-422-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "CHARLES",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-13",
"last_updated": "2022-02-25",
"certification_date": "2022-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "O--0448",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.